Deformability of cord blood vs. newborns’ red blood cells: implication for blood transfusion

Arbell, Dan; Bin‐Nun, Alona; Zugayar, Diaa; Eventov‐Friedman, Smadar; Chepel, Natalia; Srebnik, Naama; Hamerman, Cathy; Wexler, Tanja L. R.; Barshtein, Gregory; Yedgar, Saul

doi:10.1080/14767058.2020.1818203

Cited by 6 publications

(2 citation statements)

References 44 publications

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“…For premature neonates, with an immature enzymatic antioxidant system, HbF plays an essential role in the progressive adaptation to the postnatal oxygen-rich environment [ 18 ]. In addition, HbF generates unbound nitric oxide much faster than HbA, which, coupled with the high deformability of fetal RBC, assures the optimal perfusion in developing fetal tissues [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

BORN study: a multicenter randomized trial investigating cord blood red blood cell transfusions to reduce the severity of retinopathy of prematurity in extremely low gestational age neonates

Teofili

Papacci

Orlando

et al. 2022

Trials

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Background Extremely low gestational age neonates (ELGANs, i.e., neonates born before 28 weeks of gestation) are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP. Methods/design BORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent, and randomization take place at 10 neonatology intensive care units (NICUs) of 8 Italian tertiary hospitals. ELGANs with gestational age at birth comprised between 24+0 and 27+6 weeks are randomly allocated into two groups: (1) standard RBC transfusions (adult-RBCs) (control arm) and (2) CB-RBCs (intervention arm). In case of transfusion need, enrolled patients receive transfusions according to the allocation arm, unless an ABO/RhD CB-RBC is unavailable. Nine Italian public CB banks cooperate to make available a suitable amount of CB-RBC units for all participating NICUs. The primary outcome is the incidence of severe ROP (stage 3 or higher) at discharge or 40 weeks of postmenstrual age, which occurs first. Discussion BORN is a groundbreaking trial, pioneering a new transfusion approach dedicated to ELGANs at high risk for severe ROP. In previous non-randomized trials, this transfusion approach was proven feasible and able to prevent the HbF decrease in patients requiring multiple transfusions. Should the BORN trial confirm the efficacy of CB-RBCs in reducing ROP severity, this transfusion strategy would become the preferential blood product to be used in severely preterm neonates. Trial registration ClinicalTrials.gov NCT05100212. Registered on October 29, 2021

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Section: Introductionmentioning

confidence: 99%

BORN study: a multicenter randomized trial investigating cord blood red blood cell transfusions to reduce the severity of retinopathy of prematurity in extremely low gestational age neonates

Teofili

Papacci

Orlando

et al. 2022

Trials

View full text Add to dashboard Cite

show abstract

“…18 In addition, HbF generates unbound nitric oxide much faster than HbA, which, coupled with the high deformability of fetal RBC assures the optimal perfusion in developing fetal tissues. 19,20 Rationale for transfusing cord blood.…”

Section: Introductionmentioning

confidence: 99%

BORN study: a multicenter randomized trial investigating cord blood RBC transfusions to reduce the ROP severity in extremely low gestational age neonates.

Teofili

Papacci

Orlando

et al. 2022

Preprint

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Background. Extremely low gestational age neonates (ELGAN, i.e., neonates born before 28 weeks of gestation), are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP. Methods/design. BORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent and randomization take place at 10 Neonatology Intensive Care Units (NICUs) of 8 Italian tertiary Hospitals. ELGANs with gestational age at birth comprised between 24 + 0 and 27 + 6 weeks are randomly allocated into two groups: 1) standard RBC transfusions (adult-RBCs) (control arm); 2) CB-RBCs (intervention arm). In case of transfusion need, enrolled patients receive transfusions according to the allocation arm, unless an ABO/RhD CB-RBC is unavailable. Nine Italian public CB banks cooperate to make available a suitable amount of CB-RBC units for all participating NICUs. The primary outcome is the incidence of severe ROP (stage 3 or higher) at discharge or 40 weeks of post-menstrual age, which occurs first. Discussion. BORN is a ground-breaking trial, pioneering a new transfusion approach dedicated to ELGANs at high risk for severe ROP. In previous non-randomized trials, this transfusion approach was proven feasible and able to prevent the HbF decrease in patients requiring multiple transfusions. Should the BORN trial confirm the efficacy of CB-RBCs in reducing ROP severity, this transfusion strategy would became the preferential blood product to be used in severely preterm neonates. Trial registration: ClinicalTrials.gov Identifier: NCT05100212

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Allogenic Cord Blood Transfusion in Preterm Infants

Teofili,

Papacci,

Giannantonio

et al. 2023

Clinics in Perinatology

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Deformability of cord blood vs. newborns’ red blood cells: implication for blood transfusion

Cited by 6 publications

References 44 publications

BORN study: a multicenter randomized trial investigating cord blood red blood cell transfusions to reduce the severity of retinopathy of prematurity in extremely low gestational age neonates

BORN study: a multicenter randomized trial investigating cord blood red blood cell transfusions to reduce the severity of retinopathy of prematurity in extremely low gestational age neonates

BORN study: a multicenter randomized trial investigating cord blood RBC transfusions to reduce the ROP severity in extremely low gestational age neonates.

Allogenic Cord Blood Transfusion in Preterm Infants

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